liver disease

NASH vs. NAFLD: What’s the Difference?

Learn about the similarities and differences between NASH and NAFLD.

Learn about the similarities and differences of NASH and NAFLD.

What are NASH and NAFLD?

Non-alcoholic fatty liver disease (NAFLD) includes two types of conditions: non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH). Both NAFL and NASH are classified as diseases of the liver but are distinct from each other. NAFL, also known as fatty liver, is a disease in which fat builds within the cells of the liver (steatosis) in the absence of any significant inflammation or fibrosis (scarring). NASH, like NAFL, has steatosis, but is associated with significant inflammation and scarring.

It is important to note that these conditions are diagnosed only in the absence of other causes of steatosis, most importantly alcohol-related liver disease(1).

Male anatomy of human organs in x-ray view

What are the similarities between NASH vs. NAFLD?

NAFL and NASH are similar in that both result from fat building up in the liver cells, predominantly in people with risk factors that include:

  • Obesity
  • Type 2 diabetes
  • Metabolic syndrome (a combination of a large waistline, high blood pressure, low HDL cholesterol, high triglycerides, and diabetes)

Both normally do not cause any symptoms and both may be incidentally discovered either through routine blood work or from an imaging study. It is also important to note that patients with NAFL and NASH are at increased risk for heart disease(1).

A diabetic patient being injected with insulin.

What are the differences between NASH vs. NAFLD?

Percent of the population with the condition
Risk factors for NAFLD include obesity, diabetes, high blood pressure, and other components of the metabolic syndrome. In the United States, approximately 30% of the population may have some form of NAFLD, with some studies reporting rates as high as 46%(1,2). Global estimates suggest approximately one in four people may be affected(3). NAFLD may be more common in certain ethnicities, such as the Hispanic population, due in part to higher rates of obesity and a genetic predisposition(4). Because the disease is largely one without symptoms, we may not know the exact number of people affected. Approximately 10–20% of people with NAFLD will be diagnosed with NASH(5).

Branch in boardwalk with two paths leading off into the distance

What treatment options are available for NASH?

Currently, there are no approved medical treatments to reverse the liver damage caused by NASH. However, there are clinical research studies that may lead to future treatments, including a NASH research study available through Science 37. If you or a loved one has a NASH diagnosis, see if you qualify for this opportunity. Compensation may be provided.



  1. Williams CD, Stenger J, Asike MI, Torres DM, Shaw J, Contreras M, Landt CL, Harrison SA. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology 2011;140(1):124-131.
  2. Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC, Grundy SM, Hobbs HH. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology 2004;40(6):1387-1395.
  3. Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease—Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology 2016;64(1):73-84.
  4. Romeo S, Kozlitina J, Xing C, Pertsemlidis A, Cox D,Pennacchio LA, et al. Genetic variation in PNPLA3 confers susceptibility to nonalcoholic fatty liver disease. Nature Genetics 2008;40(1):1461-1465.
  5. Younossi ZM, Blissett D, Blissett R, Henry L, Stepanova M, Younossi Y, Racila A, Hung S, Beckerman R. The Economic and Clinical Burden of Nonalcoholic Fatty Liver Disease in the United States and Europe. Hepatology 2016;64(5):1577-1586.

Dr. Motola received his MD, PhD from the University of Texas Southwestern. He went on to complete his Internal Medicine residency at Mount Sinai Hospital, followed by a Gastroenterology fellowship at Massachusetts General Hospital. His interest in liver disease led him pursue a fellowship in Transplant Hepatology. Dr. Motola has first hand insight into the most pressing clinical questions and issues surrounding the care of pre- and post-transplant patients, as well as patients with a variety of chronic liver diseases, specifically non-alcoholic steatohepatitis and chronic hepatitis B and C infection.


  1. This sounds like what my doctor says I have. My doctors only advice is to loose weight. I have lost weight during the 4 monthes she has monitored me. My enzymes in my liver have only gone up. Now she tells me I could go into liver failure. I am scared and now I am having trouble losing anymore weight. Please if you gave any additional advice, help. Thanks

  2. This is very interesting. I was diagnosed with a fatty liver many years ago and now have cirrhosis of the liver. I have no heart problems or diabetics just over weight. I would like to know of this disease.

  3. My doctor made study the blood test and always I have cholesterol and he said is genetic !!! What I do??? Let me know plz ???

  4. I have been struggling with wright loss, I can’t get rid of my gut . I have notice carbs make it worst. Also when I have a glass of wine
    I’m currently doing a liver cleanse

  5. I don’t drink, am not overweight, really don’t eat sweets and am not a carb-a-holiday, yet diagnosed with Type 2 and fatty liver 7 years ago. No family history…

  6. My doctor said I have a fatty liver and Diabetes
    and I need help, I’m scared.

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